Provider Demographics
NPI:1851043145
Name:BOURAS, ALEXIS J (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:BOURAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 TIMKA DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3741
Mailing Address - Country:US
Mailing Address - Phone:314-713-8983
Mailing Address - Fax:
Practice Address - Street 1:816 S KIRKWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6056
Practice Address - Country:US
Practice Address - Phone:314-686-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2023-03-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant